(AND it gave me a reason to finally signed up for a free one month trial of NETFLIX)
If you are unfamiliar with the movie, here is the trailer
Running Diary of Business of Being Born
In order to fully capture the moments that resonated with me, I decided to take the SportsGuy running diary approach to covering this movie. What follows are the moments in the film that I thought presented interesting points of discussion. The comments in red are my asides. Please feel free to comment!
5 minutes in: We are introduced to Ricki Lake (yes that Ricki Lake), who we learn wanted to have a natural birth and felt robbed of this experience after delivering her first child in the hospital.
In order to understand the "culture" of natural birth advocates (her second child was a natural birth), she began attending numerous birthing conferences. She attended primarily to learn more about the process of labor and delivery in this country from both patients and providers, specifically with the goal of educating women about their choices in childbirth.
In order to understand the "culture" of natural birth advocates (her second child was a natural birth), she began attending numerous birthing conferences. She attended primarily to learn more about the process of labor and delivery in this country from both patients and providers, specifically with the goal of educating women about their choices in childbirth.
The Experts:
We meet Michael Odent, a French obstetrician and independent researcher who by some accounts launched the idea of water birthing. A simple pubMed search shows that he has published extensively in Midwifery Today - International Midwife about a myriad topics on childbirth from questioning the widespread use of synthetic oxytocin to preparing the fetus for the ejection reflex. He also is part of the Primal Health Research Center and BirthWorks, an organization and philosophy that "embodies the philosophy of developing a woman's self confidence...in her innate ability to give birth."
We meet Michael Odent, a French obstetrician and independent researcher who by some accounts launched the idea of water birthing. A simple pubMed search shows that he has published extensively in Midwifery Today - International Midwife about a myriad topics on childbirth from questioning the widespread use of synthetic oxytocin to preparing the fetus for the ejection reflex. He also is part of the Primal Health Research Center and BirthWorks, an organization and philosophy that "embodies the philosophy of developing a woman's self confidence...in her innate ability to give birth."
Susan Hodges, president of Citizens for Midwifery states that
very few doctors have ever seen a normal birth in residency or med school. I get it...perhaps "natural birth" is what she means though and we go on to meet what appear to be NYU OBGYN residents who confirm that they rarely see a “natural birth.”
Not surprised, as a resident I probably attended less than 10 "natural births." I will never, however, forget the woman from South America who did not want to deliver in lithotomy or be monitored so we let her deliver standing up. Despite both patient and myself being stressed out initially, both mom and baby did great and that was a pretty cool experience!
Not surprised, as a resident I probably attended less than 10 "natural births." I will never, however, forget the woman from South America who did not want to deliver in lithotomy or be monitored so we let her deliver standing up. Despite both patient and myself being stressed out initially, both mom and baby did great and that was a pretty cool experience!
Jacques Moritz is an OBGYN in NYC and states that for low risk women – going to an OBGYN
is probably overkill...there is some truth to this but in order to learn whether you are "low risk" you probably need to consult a medical professional.
7 minute mark: We meet another midwife who says that OBGYNs are trained
surgeons followed by the President of Choices in Childbirth (Elan McAlister) who states
that OBGYNs should be doing surgeries "all day everyday” and not normal births
because they are not trained in it and have no idea how to do it.
WOW! That is a pretty big statement to make - perfect rhetoric for the movie!
Marsden Wagner, former WHO Women and Children’s Health director and advocate of midwifery services is introduced.
10 minutes in: We are greeted with information of smear
campaigns in the early 1900s against midwifery as hospitals promoted themselves as "clean" alternatives. Interestingly as OBGYNs graduated medical
school over the 20th century we are told that many had never even performed a live birth delivery- really?
We also learn that as more OBGYNs train, the more patients were driven to delivering in hospitals because "that is where the OBGYNs were"...additionally, we are told that midwives were cut off from the birthing process because they were not being allowed in the hospitals.
We also learn that as more OBGYNs train, the more patients were driven to delivering in hospitals because "that is where the OBGYNs were"...additionally, we are told that midwives were cut off from the birthing process because they were not being allowed in the hospitals.
Yes, finally, at the 12 minute mark we see the labor board at
what appears to be a NYC OBGYN residency program with residents running the board. We hear the words "pitocin," and “pit” like 40 times in this heavily edited montage which speaks to the common lingo heard around most labor board sign outs. We get interviews with
folks who appear to be house staff talking about "augmenting patients...if they don’t change.” And then we are told that where there is pitocin there is a lurking epidural!
For patient privacy reasons we do not know any details about the patients on that board. Many patients may have been high risk and required medical intervention. We will never know, but in my opinion, the portrayal here is edited to satisfy the movie's message: physicians are seemingly oblivious to the natural birthing process.
For patient privacy reasons we do not know any details about the patients on that board. Many patients may have been high risk and required medical intervention. We will never know, but in my opinion, the portrayal here is edited to satisfy the movie's message: physicians are seemingly oblivious to the natural birthing process.
15 minutes in: we are introduced to the following hospital birthing logic: women get pitocin = stronger contractions = more pain = epidural = slow labor = more pitocin = ultimately poor tracing = cesarean section!
Next an OBGYN describes how the lithotomy position was invented for the convenience of
the doctor and by its nature increases the risk of operative delivery and need for episiotomy.
18 minute mark: Choices for Childbirth president describes the most common explanation for intervening: "we need to deliver you now for the good of the
baby"
While this phrase gets over used...in all fairness most physicians say it because it is accurate: there was a cord prolapse, a uterine rupture, or an unresponsive fetal bradycardia...frankly if there is no indication to intervene - you avoid it!
While this phrase gets over used...in all fairness most physicians say it because it is accurate: there was a cord prolapse, a uterine rupture, or an unresponsive fetal bradycardia...frankly if there is no indication to intervene - you avoid it!
21 minute mark: we learn that Ricki thinks women in this
country are not interested in the process of giving birth, and are more interested
in just taking home a healthy baby and wants this project to speak to that and
give women perhaps a greater appreciation of the process.
23 minute mark: Birth is a right of passage and it can be
wonderful experience or it can be a terrible “scarring” one
28 minute mark: We witness a waterbirth - awesome - it is not Ricki's though...that is coming up
36 minute mark: ok this is an issue: the rising C-section rate and the slew of celebrities promoting (perhaps unintentionally?) elective C-section...a good 6 minutes of movie time spent on this issue - which is important
42 Minute mark: AWESOME! grainy video of ricki lake doing a home birth! I have officially arrived at documentary NIRVANA
On the idea of home birth: we are presented with several physicians who present their concerns: prolapsed cord, postpartum hemorrhage, etc – but this is rebutted with footage suggesting that trained midwives are prepared with pitocin drawn up and IV ready and access to intrapartum services if needed.
The American College of Obstetricians and Gynecologists (ACOG) view on planned home birth is below
The American College of Obstetricians and Gynecologists (ACOG) view on planned home birth is below
In the next clip, it is suggested that the American Medical Association (AMA) is against midwives?
After reviewing the AMA's policy on midwifery scope of practice it does not seem to be.
After reviewing the AMA's policy on midwifery scope of practice it does not seem to be.
Final 15 minutes: Choices for Childbirth president
speaks out about the abuses committed daily in obstetric practice and that interventions are not
based on science or medicine, but by physician convenience and economics.
This lady was soundbite gold for the filmmakers!
This lady was soundbite gold for the filmmakers!
Someone (perhaps Dr Wagner, can't remember) suggests that increased interventions are leading to increasing neurologic problems in children.
Not going there
We finish with the filmmaker's experience with childbirth. She happened to get pregnant while planning this documentary. She sees a midwife and considers a home birth. At what appears to be 36+ weeks she is determined by the midwife to be breech. Dr Mortiz is her OBGYN and we understand that he is her back-up in case.
We are then shown images of her in labor at home and the midwife determining that she is dilated, still BREECH, and in need of transfer to the hospital where Dr Moritz is on standby for a c-section. In true NYC fashion she takes a cab to the hospital breaks her water while inside...she did not prolapse her cord thankfully.
While it seems she had ultrasounds with Dr Moritz, we learn that her child is growth restricted (weighing 3 lbs) and her son spends an unspecified time in the NICU. The documentary ends after we see the child 8 months later doing well with mom and Ricki.
This ending sequence spoke to the kind of patient WHO SHOULD NOT be a home birth candidate. While it is not clear how long the patient labored at home, it would make sense for any patient known to be breech to be evaluated in an intrapartum setting.
The ACOG position on planned home birth is noted below (FROM ACOG CO #476)
Facts:
- 25,000 births (0.6%) are at home and 1:4 are unattended or unplanned
- in a meta-analysis of observational studies comparing home birth with hospital birth, the perinatal mortality rate is similar between the two groups, BUT among non-anomalous newborns, the home birth group had three times the risk of neonatal death
- planned home births are associated with fewer interventions, fewer lacerations and similar postpartum hemorrhage rates
- as studies on home birth are performed on healthy pregnant women, strict criteria must be met when determining whether one is even a candidate for home birth: no medical problems, normal labor, head must be head down, access to safe, timely transfer to intrapartum unit
- not all midwifes are created equal: ACOG supports the provision of care by midwifes certified by the American Midwifery Certification Board.
ACOG's Summary position on planned home birth (my paraphrase):
Hospitals and birthing centers are the best setting for delivery, however ACOG respects the rights of women to make medically informed decisions about their healthcare. Patients must be informed about the risks of a home birth, specifically the increased risk of neonatal death noted above and should be informed whether or not they are a candidate for a home birth. They must have access to a certified midwife and/or physician as well as an intrapartum unit in order to maximize the chance of a favorable birth outcome.
Not going there
We finish with the filmmaker's experience with childbirth. She happened to get pregnant while planning this documentary. She sees a midwife and considers a home birth. At what appears to be 36+ weeks she is determined by the midwife to be breech. Dr Mortiz is her OBGYN and we understand that he is her back-up in case.
We are then shown images of her in labor at home and the midwife determining that she is dilated, still BREECH, and in need of transfer to the hospital where Dr Moritz is on standby for a c-section. In true NYC fashion she takes a cab to the hospital breaks her water while inside...she did not prolapse her cord thankfully.
While it seems she had ultrasounds with Dr Moritz, we learn that her child is growth restricted (weighing 3 lbs) and her son spends an unspecified time in the NICU. The documentary ends after we see the child 8 months later doing well with mom and Ricki.
This ending sequence spoke to the kind of patient WHO SHOULD NOT be a home birth candidate. While it is not clear how long the patient labored at home, it would make sense for any patient known to be breech to be evaluated in an intrapartum setting.
The ACOG position on planned home birth is noted below (FROM ACOG CO #476)
Facts:
- 25,000 births (0.6%) are at home and 1:4 are unattended or unplanned
- in a meta-analysis of observational studies comparing home birth with hospital birth, the perinatal mortality rate is similar between the two groups, BUT among non-anomalous newborns, the home birth group had three times the risk of neonatal death
- planned home births are associated with fewer interventions, fewer lacerations and similar postpartum hemorrhage rates
- as studies on home birth are performed on healthy pregnant women, strict criteria must be met when determining whether one is even a candidate for home birth: no medical problems, normal labor, head must be head down, access to safe, timely transfer to intrapartum unit
- not all midwifes are created equal: ACOG supports the provision of care by midwifes certified by the American Midwifery Certification Board.
ACOG's Summary position on planned home birth (my paraphrase):
Hospitals and birthing centers are the best setting for delivery, however ACOG respects the rights of women to make medically informed decisions about their healthcare. Patients must be informed about the risks of a home birth, specifically the increased risk of neonatal death noted above and should be informed whether or not they are a candidate for a home birth. They must have access to a certified midwife and/or physician as well as an intrapartum unit in order to maximize the chance of a favorable birth outcome.
I'm so glad you're doing a review of this documentary. Ben and I are going to start trying for a baby soon, and I've been very interested in alternatives to hospital births, mainly because of the super high C-section rate in the US. My mom had me 11 days late, in 4 hours, with no drugs or interventions. I know I'm not her, but it's a scenario that I don't think happens very often anymore. I felt that the doc had a good message but villaified OBGYNs. I hope that, if we're able to get pregnant, I can find a doctor and a midwife that will help us make the best decisions for us. Thanks for posting this!
ReplyDeleteSuze,
ReplyDeleteThanks for reading the post. Some comments if I may: The c-section rate is hovering around 30% and the field as a whole is examining how to keep it from climbing further and is working to reduce the numbers: http://consensus.nih.gov/2010/vbac.htm
You describe your mother's birth lasting a short time. I would be curious what your older sister's childbirth was like...**typically** the first childbirth is the longest, after which they are **typically** shorter. Ultimately, many patients who come for delivery request an epidural.
when you get pregnant lean on the advice/recommendations of friends, especially those that might share your same expectations on what you want with childbirth, but keep in mind that everyone's experience will be different even if you control for the same MD and/or midwife...one thing I see time and time again with patients in our infertility practice and even with my wife's pregnancy is that the "loss of control" is SO frustrating!
Thanks again for commenting, if you are interested in other topics don't hesitate to message me via facebook or the blog itself